EX 46 Claim Denial Issue

Date: 08/29/18

Heritage Health (Medicaid):

Nebraska Total Care has identified that beginning on June 18, 2018 some claims for a set of procedure codes (see below) for covered services incorrectly denied as non-covered services under denial code EX 46. This issue is specific only to EX 46 denials that may have been received for the identified procedure codes.

Some of the procedure codes impacted are not found on the Nebraska Medicaid Fee Schedule(s) yet are covered services when billed with a modifier. Nebraska Total Care will include this issue on our Known Issues Log with reprocessing project information.

If you have questions, please contact Provider Relations.


CPT Code	CPT Code	CPT Code	CPT Code	CPT Code	CPT Code
20808	61711	75894	82271	93451	A9515
20920	64681	75898	82272	93452	A9582
20922	64809	75956	82495	93453	C1767
21245	64818	75957	83516	93455	C9028
21246	64820	75958	83625	93566	C9029
28735	64821	75959	84311	93702	C9745
37197	64822	75970	84630	93792	C9746
37616	64823	76001	85557	95806	C9747
37650	70557	76120	85613	95866	E0465
43845	74190	76125	85670	96377	E0466
43846	74235	76932	86329	97161	E0603
46260	74301	76940	86480	97162	G0237
46706	74328	76941	86611	97607	G0279
49324	74329	76945	86622	97608	G0283
49326	74330	76975	86631	97610	G0433
50020	74340	76998	86632	97802	J1428
50400	74355	77022	86784	97803	J1627
50405	74360	77520	87081	97804	J7181
54900	74363	77522	87798	99151	J7182
54901	74425	77523	88313	99152	J9203
55400	74445	77525	90587	99153	J9325
58410	74450	78282	90625	99156	P9016
58541	74470	78808	90657	99157	P9045
58542	74742	80053	90660	99485	Q2040
58543	74775	80306	90672	99486	Q4102
58544	75801	80400	90700	A0180	Q4107
58999	75803	82024	90739	A0200	S0119
59140	75805	82150	90750	A0210	S9960
60600	75807	82247	91299	A0888	S9961
60605	75810	82270	92921	A4623